New or Established Patient

January 17, 2019

Question:I am new to Orthopaedics. I am in a practice that employs a joint specialist, spine specialist and a pediatric orthopaedic surgeon in addition to general orthopaedic surgeons. Do the new patient rules apply to each of these specialties? For example, a patient is first seen by the general orthopaedic surgeon and then is sent to the spine surgeon. Is the spine surgeon able to report a new patient visit because he is a different specialty?

Answer:Welcome to the world of Orthopaedics. Your question is a good one. Medicare defines the specialty designations that most payors use; while in practice there are many subspecialties within orthopaedics, Medicare only defines Hand and Sports Medicine as different specialties. Sports Medicine is typically designated by primary care sports medicine physicians, not orthopaedic surgeons. While the spine and pediatric surgeons are subspecialists, Medicare assigns them to the Orthopaedic specialty category. In your scenario, the spine surgeon will report an established patient visit if the patient is seen within 3 years of his orthopaedic colleague’s visit.

*This response is based on the best information available as of 1/17/19.